Mô tả hành vi nguy cơ nhiễm HIV và xác định tỷ lệ nhiễm của nhóm nghiệm ma túy tham gia chương trình dùng thuốc thay thế methadone tại thành phố hà nội

Y HOC VIET
NAM
THANG 2 - SO 2/2014
trung binh (46,6%).
Loai
thieu
mau
dang
sac
hong cau binh thffdng chiem 59,3%. 62.5% thieu
mau khdng
do cac
benh
ly
tiiy
xffdng
vdi
tiiy
dd
binh thffdng hoac tang sinh lanh tfnh dong
HC.
Benh mau
ac
tinh
la
nguyen nhan
gay
thieu
mau
chiem
23,1%.

Tiiy
dd la
bffdc quan trong
de
chan
doan nhieu
rdi
loan huyet hoc gay thieu mau.
TAI UEU THAM
KHAO
1.
Ahmad
SQ,
Khan
OU,
Zafar
N.
Utility
of
Bone
Marrow Examination
in
a
Secondary Care Hospital
JRMC
2011;15:40-1.
2.
AsimMomani,
RameKhasawneh
(2012).

Spectrum
of
Bone
Man-ow
aspirabon test resultsat
Prince
Rashid
Hospital/Jordan.
A 3
Year
Experienceint J
Biol Med Res. 2012; 3(2):
1648-1650
Egesie OJ, Joseph DE, Egesie UG,
Ewuga
03.
Epidemiology
of
anemia necessitating bone
marrow aspiration cytology
in
Jos. Niger Med
J.
2009;50:61-1.
Jha
A,
Sayami
G,
Adhikari RC, Panta D, Jha
R. Bone marrow examination

In
cases
of
pancytopenia,
J
Nepal Med Assoc 2008;47:12-7.
Khodke
K,
Marwah
S,
Buxi
G,
Yadav
RB,
Chaturvedi
NK.
Bone Marrow Examination
in
Cases
of
Pancytopenia.
JIACM
2001;2;55-9.
Laishram
S,
Shimray
R,
Sharma
AB,
Pukhrambam

G,
Singh
AM,
Sharma
LDC
Neoplastic lesions
in the
bone marrow:
a
10 year
study in a teaching hospital. JIACM 2008;9;175-8.
Pudasaini, Prasad
KBR
(2012). Interpretation
of bone marrow aspiration
in
hematological
disorder Journal
of
Pathology
of
Nepal (2012) Vol.
2,
309 -312
MO TA HANH VI NGUY
Ca
NHIEM HIV VA XAC
DINH
TY LE NHIEM HIV
COA

NHOM
NGHIEN CHICH MA TUY THAM GIA
CHU'ffNG
TRINH
DUNG THUOC THAY THE METHADONE TAI
THANH
PHO HA NOI
T6M TAT
Nghien ciTu mo
ta cat
ngang dffpc thffc hien tren
400
ngi/di
nghien chfch
ma tuy tai 02 co sd
dieu
trj
Methadone
tai
thanh phd Ha
Npi.
Ket qua nghien
cyu
cho thay: Ngffdi nghien chfch ma tuy dang doi mat vdi
cac hanh
vi
nguy
cd lay
nhiem
HIV

nhi/
tud'i
bat
d'au
tiem chich
ma
tuy,
sff
dung chung bdm kim tiem
khi
hem chfch
ma tuy va
khdng
sy dyng
bao cao
su cho
tat ca cac lan quan he tinh
dye.
Day chfnh
la
cac hanh
vi nguy cd can
dupe
can thiep
nhSm
lam giam
ty le lay
nhiem HIV trong nhdm ngffdi nghien chich ma tuy.
SUMMARY
EVALUTION ON

INJECHON
DRUGS USERS
(IDUS)
IN
TWO METHADONE TREATMENT
CENTERS
IN
HANOI CITY
The cross
-
sectional descnptive study was done
on
400
injecction
drug users
in 02
methadone
treatment centers
in
Hanoi city.
The
study results
showed
that;
injection drug users who are facing risks
behavior
for
HIV injection such as
mibabon
of

injection
daig
use, sharing needles used
to
inject drugs and
not
Bui Thi Nga*, Nguyen Anh Quang*,
Nguyen Thanh Long**
using condoms
for all sex
times. This
is the
risk
behavior interventions should be aimed
at
reducing the
prevalence
of
HIV infection among drug injectors.
Tit khoa:
HIV/AIDS,
Nghien chich
ma
tuy,
Hanli
VI
nguy
cd.
Ha Npi
I.

OJ^TVANDE
Theo
bao cao cua Bp Y te
tinh
den
ngay
30/6/2013
so cac
trffdng
hdp
nhiem
HIV con
sdng
la
213.413 ngffdi, trong do cd 63.373
ngufli
bi AIDS
va
65.133 ngffdi
tff
vong
do
AIDS
[1).
Cac dffdng lay truyen HIV
chii
yeu
d
Vi|t
Nam la

diing chung bdm kim tiem (BKT)
khi
tiem chich
ma
tuy
(TCMT)
va
hanh
vi
hoat dpng tinh
due
khdng
an
toan. Khdng
chi co
hanh
vi
tiem chich
va tinh
due
khdng
an
toan
la cd
nguy
ai lay
nhiem
HIV ma
tinh trang nguy
cd

cua ban tinh
hoac ban chich cung
cd vai trd dff
bao nguy
aJ
*
Trung tam phdng chdng HIV/AIDS
Ha Ngi
**BdYti
Phan
bign
khoa
hgc:lS.
Nguyen Quoc Trffdng
Y HQC VlgT NAM THANG 2 - SO 2/2014
nhiem HIV, Dung chung BKT vdi mot ngu'di co
ten so
tiem
chich tren 1 lan mot
ngay'hoac
ngu'di
CO tuoi^ddi
nhieu (nghTa la
nhjng
ngu'di cd nguy
cd nhiem trang qua khir Idn hdn) thi cd ty le
nhiem HIV gap 2 ian (43% so vdi
18%)
so vdi
nhu'ng ca the cd nguy cd thap [4],

Hanh vi tiem chich ma
tiiy ciia
ngu'di nghien
chi'ch ma
tiiy
(NCMT) la mot yeu to rat cao lam
gia tang lay nhiem HIV d Chau A; dien hinh la
Trung Qudc, Indonesia va Viet Nam. Phan Idn
nhu'ng ngu'di NCMT dang d do tudi cd nhu cau
quan he tinh
due
cao, nhieu ngu'di NCMT cdn
tham gia vao hoat dpng mua ban dam,
sir
ket
hijp
nay cang lam cho nguy cd lay nhiem HIV ra
cpng dong.
Tai
Thanh php Ha Npi, tfnh den 30/6/2013,
luy
tich _cac tru'dng
hdp
ngu'di
nhiem HIV
di/dc
phat hien la 20.524 hien cdn song, trong do
5.272 tru'dng hdp chuyen sang giai doan AIDS va
3.802 ngirdi tir vong do AIDS. Hien nay dich van
dang trong giai doan tap trung va ty le nhiem HIV

cao nhat la trong nhdm NCMT (67,4%), Hep den
la quan he tinh
due
22,8 %. Dich HIV/AIDS d
Thanh pho Ha Npi cd lien quan mat thiet vdi tinh
trang gia
tang_^trong
nhdm doi
tiTdng
NCMT [6].
DeJ:ai
nham
mijc
tieu "Mo ta hanh vi nguy cd
lay nhiem HIV va xac djnh ty le nhiem HIV
ciia
nhdm nghien chi'ch ma tuy tham gia
chddng
trinh
diing thuoc thay the Methadone tai thanh pho Ha
Npi"
lam cd sd xay di/ng cac hoat dong can thiep,
gdp phan lam giam
sir
lay truyen HIV [6], [7].
II.
OOI TUplMG VA PHU'ONG PHAP NGHIEN OJll
-
Dia
diem nghien

ciru:
Tai 02
quan/huyen
Ha
Ddng va Tir
Liem,
TP Ha
Npi.
-
Thdi
gian nghien
ciru:
tir thang 1/ 2012 den
thang 12/2012
- Ddi
tdOng
nghien
ciru:
La ngirdi nghien chich
ma tuy sii dung cac loai ma tuy bang bdm kim
tiem theo tinh mach.
- Phu'dng phap nghien cu'u: ap dung thiet ke
nghien ciru md ta cat ngang. Cd mau du'dc tinh
thep
cong thirc
tinh;
" =
Zn 2,
P-(l-p)/d'
n ; la

cd mau
2:
la he sd tin cay, vdi ngu'dng sac xuat
a =
5%,
tacd:
2|,_„
,,=
1,96
P
=
0,4 -
Ty
le
nhiem HIV trong nhdm
dot
tddng
NCMT nam 2009
(theo dieu tra IBBS nam
2009
ciia
TP Ha Npi).
d = 0,023 sai sd cho phep

n = 370
ngi/di.
DU phdng phieu khong hdp le 10%, udc tinh bd
cupc va lam trpn ta cd cd mau nghien
ciJu
la 400.

III.
Kft-QUA NGHIEN Cl>U
3.1.
M§t
so
d^c
tru'ng ca nhan cua ngu'di
nghien
chich ma tiiy
Bang
1: Dac diem ve nhdm tud'i va trinh dp hpc van (n= 400)
£)ac
tru'ng
Nhom tuoi
< 20 tuoi
20-29
30-39
>40
Hoc van
Mil
chii'
Tieu hoc
Phd thong cd sd
Phd
thdng trung hoc
Dai hoc, cao dang
Ty le
(»/o)
3,80
47.00

33,70
15,50
0,50
13,30
44,00
38,80
3,40
Trtmg so 400
doi tudng
nghien
cdu
nhdm
tuoi
td20 den
29
chiem
47.0%,
tiep
den
la
nhdm
tudi
td30
den 39
(33,7%),
thap nhat
la
dddi 20 tuoi (3,8%).
Ve Trinh
do hoc

van:
Nhin chung cac
doi
tddng co
trinh dg
hpc
van
tddng ddi
thap.
Trong
dd,
phd
thong cdsd chiem
ty le
cao
nhat
(44,0%),
phd thdng
tmng hgc
(38,8%),
tieu hoc
(13,3%),
dinh do Dai
hgc,
cao dang chiem
(3,4%),
dSc
biet
cd
0,5%

doi
tudng mu
chd.
Y HOC VIET NAM THANG
2 -
SO
2/2014
Bieu
do.l.
Phan bd theo nghe nghiep cua ngffdi nghien chich ma tuy_
•
60.5
Chu kinh
doaiiii'buon
biin
^ggg
6.:
Nhan
\'ien phi.ic
\
1.1.
bill haiiE ^|^
S
Nhan
\ ien
nha
nirac
|
0."
Trong

nghiin
c&u
cho thiy
Ng&di
NCMT lam rit
nhieu nganh
nghi
khac
nhau trong dd tap
trung chij
yiu la nghi t&do
(60,5%),
nhan vlin ban hang (8,5%) va lam rugng
(7,5%).
Ngoai
ra
cdn mgt so
cong
viec khac
nh&:
chu kinh
doanh
(6,2%),
sinh vlin
(2,5%),
nhan
vien
Nha
n&dc
(0,7%)).

Dac
biet,
CO
14,1%
ddi
t&dng
khong co
viec
lam.
Hau
hit dd la
nhu'ng
cong
viec
lao dgng chin tay, tliu nhip
thap
va khong
on
dinh.
3.2. Cac yeu to hanh vi nguy cd lay nhilm HIV cua nhom NCMT
BieudoZyhn
suat tiem chich ma tuy trong 1 thang qua
it hon !
Imvngay
S.7
I lan/ngay .
2-3
larVngay \,^l
Tren
3

lan/ngay
HH|
6
'•^.i :rji:i-
^rtidAaJ
-J^V
J 53.5
20 40
50
Ty
le
ng&di NCMT dting TCMT
mgt
ian
mot
ngay
chiim
31,8%,
ddng hai din ba lan mpt
ngay chiim
ty li
cao
nhit
53,5%,
It
hdn
1
lan/ngay
chiim 8,7
%,

dt/ng trin S lan/ngay chiim 6,0 %.
Tan suit
siJ'
dung
thudc trong
ngay
khong nhu'ng
phu thupc
vao
m&c
dp nghiin nang hay
nhe,
ma
con
phu
thugc
vao kha nang kinh ticua ng&di
NChlT.
Bieu do 3. Hanh vi
diJng
chung BKT khi TCMT trong 1 thang qua
iCo MK.li6n2
Kit
qua cho
thiy
co 91,7%)
ng&di NCMT
khong
s&dung
chung

BICT nh&ng
van
con tdi 8,3%
ng&di
NCMT van s&dung chung
BKT.
Y
HOC
VIET
NAM
THANG
2 - SO
2/2014
Bleu
ad
4. Tan suat diing BCS khi QHTD vdi GMD trong 12 thang qua
Khong bao gid
Doi khi
Da sd cac lan
Tat ca cac Ian
0.7
LI
2.5
0 20
60
:,:;^
,J
87.9
80 100
Kit

gua
cho thay tan xuat sd dung
BCS
khi
quan
he tinhd
due
(QHTB) vdi
gai mai
dam
(GMD)
trong
12
thang
qua kha cao chiem
87,9%
trong tat ca
cac
lan.
Tuy
nhien
van cdn 11,4% khong thddng
xuyen
va
0,7%
khong
bao
gid
sddung
BCS.

Bang
2. Mot .6
mdi
lien quan tdi hanh vi sir dunq chunq bdm kim
tien'
Dac tinh
Trinh
dp hpc van
Thdi gian nghien
<
Idp 9
>
Idp 9
Tir
2
nam trd len
Dddi 2 nam
Sii dung chung BKT
Co
25 (28,7)
8
(2,6)
31 (10,9)
2(1,7)
Khong
62 (71,3)
305 (97,4)
253 (89,1)
114 (98,3)
OR

15,4
6,9
Phan
tfch mdi liin quan
gitj^
hanh vi s&
dung
chung
BICT
va
nh&ng
yiu td
khac
cho
thiy:
Nhung
ng&di
NCMT
cd
trinh dp
hpc vin
d&di
pho thdng trung hgc co nguy cd s&
dung chung
BKT
cao
gip
15,4
lan so vdi ng&di co trinh dp hpc vin trin phd
thdng

trung
hgc.
Phan
tich cijng chi
ra
la cd s&
khac
biet
trong
hanh
vi
s&dung
chung
BKT
cua
nhung
ng&di
NCMTco
thdi
gian nghiin
d&di
2
nam
va
tren
2
nam.
nhii'ng
ng&di
NCMT

trin 2
nam
cd
nguy
cd
s&dung
chung
BKT
gip
6,9
lan
so
vdi
ng&di
NCMT
d&di
2
nam.
Bie'u do
5.
Ty le nhiem HIV trong nhdm ngffdi
NCI^T
\
100
•
80
60
^.•m
Ha
Dong

Tir liem
y Duong tinh
HAm
tmh
I
Kit
qua
xet nghiim HIV trong
nhdrrTbinh
nhan
NCMT
tham
gia dieu tri
nghien
thay the
Methadone
taicdsdhuyen
TdUemcdtyle
HIV
dddng
tinh la 18 %
va
d
quan
Ha
Bong
cd ty le HIV
dddng
tinh
ii 7,0

%.
IV.
BAN
LUAN
Ket qua nghien ciru cho thay ty le benh nhan
dutjc dieu
tr| Methadone da phan la d lii'a tud'i tre
tir 20 - 39: Trong dd nhdm tudi 20-29 chiem
47,0%
va nhdm tud'i 30 - 39 chiem
33,7%.
Cac
doi
tiTdng
sir dung ma tuy tap trung d dp tuoi lao
dpng,
de tiep can vdi ma
tiiy
dac biet la tiem
chich ma tuy, do dd lam gia tang manh
sir
phat
trien te nan ma
tiiy
trong nhu'ng
nSm
gan day.
Da
50
ngudi NCMT dang trpng dp tuoi lap dpng

W
Y HOC VIET NAM THANG 2 - SO 2/2014
va la nhffng tru cdt cua gia dinh do vay se lam
anh hu'dng nghiem
trpng
den kinh te gia dinh ndi
rieng va kinh te xa hpi ndi chung. Theo mdt so
tac
gia
nghien cffu
d
nffdc ngoai da tong ket thi
cd mdi lien quan rat ro ret giO'a tudi sff dung
TCMT, QHTD va ty !e nhiem HIV, nghia la cang
nhieu khach hang va dac
biet
la nhieu khach
hang la thi cang tang nguy cd bj lay nhiem HIV.
Trong nghien cffu cho thay, cd den 53,5% sd
ngffdi NCMT cd tan suat TCMT tff 2 den 3
lan/ngay, 1 lan/ngay la 31,8%. Ty le cd tan suat
TCMT tren 3 lan/ngay la 6,0%. Day cung chinh la
hanh vi nguy cd lay nhiem HIV. Theo quan sat
cua chung tdi, mac du BKT ludn san cd nhffng do
dac thu cua ngffdi NCMT la thffdng giau diem cac
hanh vi tiem chich va thieu hieu biet ve
tinh
nguy
hiem cua sff dung chung BKT [6].
Trong nghien cffu nay cdn tdi 8,3% ngffdi

NCMT van sff dung chung BKT. Viec sff dung
chung BKT trong tiem chfch la hanh vi dan den
nhiem HIV nhanh nhat do xac suat lay nhiem qua
dffdng tiem chfch la rat cao. Ben canh dd, viec
ngffdi NCMT chiu anh hffdng Idn tff cac thanh
vien khac trong nhdm nen viec hp cd hanh vi
tiem chich chung la dieu de xay ra, cang de lam
tang nguy cd lay nhiem
HIV
trong nhdm. Tuy
nhien ket qua hanh vi sff dung chung BKT nay
thap hdn so vdi vdi ket qua nghien cffu giam sat
hanh vi nam 2005 d TP Hd Chf Minh 37%, An
Giang 33%, Oa
Ninq
29%, Can Thd 25% [3].
Trong nghien cffu cd den 87,9% ngffdi sff
dung BCS khi QHTD vdi gai mai dam trong 12
thang qua, 11,4% sff dung khdng thffdng xuyen
va khong bao gid sff dung chiem 0,7%. Nhff vay
quan he tinh
dye
vdi GMD, la nhffng ngffdi khd
cd the biet dffdc hg cd nhiem
HlV^hay
khdng la
mdt nguy cd cao lam tang lay nhiem HIV trong
nhdm nay va cho ban tinh cua hp. Oong
thdi,
hp

cd the lam lay truyen
HIV/STIs
cho khach hang
va ban tinh neu khdng su
dyng
BCS. Mpt sd
nghien cffu trpng va ngoai nffdc cung da chi ra
rang GMD khdng sff dung BCS thffdng xuyen se
cd nguy cd nhiem HIV/STIs cao gap tff 2 den 20
lan nhdm GMD thffdng xuyen sff dung BCS [3].
Ket qua nghien cffu cho thay ty le ngffdi
nghien chfch nhiem HIV la 23%, vdi nhffng ngffdi
nghien chfch nay neu khdng sff dyng BKT sach
va
sff
dung BCS khdng thffdng xuyen la mpt trong
nhfftig
nguy cd tiem an lam lan truyen HIV, dac
biet lam lan truyen HIV tff ddi tffdng nguy cd cao
sang doi
tu'idng
nguy cd thap la vd, con va nhffng
ban tinh cua hp. Theo
ket qua
nghien cffu
ciia
cac
tac gia trong nu'dc thi tudi sff dung
TCMT_tre
va

quan he tinh
due
cang sdm
thi
nguy cd nhiem HIV
canci
cao do kien thffc ve
each plidng
chdng lay
nhiem HIV han che, nen khdng tff bao ve dffdc
ban than trffdc nguy cd nhiem HIV
[3],
[5].
V. KET LUAN
Ngffdi nghien chi'ch ma tuy tai Thanh phd Ha
Noi dang phai
i5di
mat vdi cac hanh vi nguy cd
lay nhiem HIV. Dung ma tuy mdt lan mdt ngay
chiem 31,8%, dung hai den ba lan mdt ngay
chiem ty le cao nhat
53,5%,
It hdn 1
lan/ngeiy
chiem 8,7 %, dung tren 3 lan/ngay chiem
6^0
%,
Cd tdi 8,3% ngffdi nghien chfch ma tuy van su'
dung chung bdm kim tiem. Trong 400 ngffdi
nghien chi'ch ma tuy tham gia vao nghien

cffu,
ket qua xet nghiem HIV cd ty le dffdng tfnh la
7,0% d Ha
Eidng
va 18% d Tff
Li^m.
TAI UEU THAM
KHAO
1.
Bp Y te (2013), Bao cao ket qua hoat dong
ptidng
chong HIV/AIDS 6 thang dau va
phffijng
hi/dng
nhiem vy 6 thang cudi nam 2013.
2.
Bo Y te
(2007),
Chydng trinh hanh dpng Quoc
gia can thiep
giam
tac
hai
trong
du"
phong lay
nhiem HIV/AIDS giai doan 2007-2010.
3. Bo Y te (2006), Chffdng trinh giam sat ket
fitff
ha'nh

vi
va cac chi sd sinh hoc
HIV/STI
(IBBS)
t?i
Viet Nam 2005-2006, Ha Npi, tr. 12- 37.
4.
Bp
Y te - Trung tam
Du*
phong va Kiem
so6t
benh Hoa
Ky-Chu'dng
trinh AIDS toan
cSu
(2003), "Cac nguyen tac
idu'
phdng HIV trong
nhdm sff dyng ma
tiiy",
Hpi thao ve dff phong
nguy cd lay nhiem HIV trong nhdm nhu'ng
ngu'S
TCI^TJai Viet
Nam,
Ha Ndi, 30/9-3/10/2003.
5. Nguyin Tran Hien, Le tru'dng Giang, Walter
Dvilles (2000), "Yeu td nguy cd nhiem HIV va
dung chung bdm kim tiem d ngffdi nghien ma tuy

tai thanh phd Hd
Chi
Minh", Tap chf
Y
hoc
thut
hanh,
sd 182.
6. Trung tam phong chdng HIV/AIDS
Hh N$i
(2013), Bao cao ket qua hoat ddng phong chong
HIV/AIDS 6 thang dau va phu'dng hffdng
nhi^
vu 6 thang
cudi
nam 2013.
7. Thu tu'dng Chinh
phii
(2012), Chien Iffdc quoc
gia
phdng chdng HIV/AIDS d Viet Nam den
n5m
2020 va tam nhin 2030